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Inspection on 09/12/05 for Morton House Nursing & Rest Home

Also see our care home review for Morton House Nursing & Rest Home for more information

This inspection was carried out on 9th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home offers nursing care and personal care to a number of residents who have complex nursing and care needs. Care is provided in a professional manner and residents look well cared for, staff interact with residents in a kind and friendly manner. The home has a homely atmosphere and residents are encouraged to live as full a life as possible within their disabilities; residents have been taken Christmas shopping and are taken out to the local garden centre and public house.

What has improved since the last inspection?

The home has implemented a disposal of medication system, which complies with new legislation. Records of furnishings and audits of room furniture are now in place including residents being risk assessed for keys to bedrooms and lockable storage space in their bedrooms.

What the care home could do better:

Care plans continue to have shortfalls regarding monthly reviews and being kept updated. This is an ongoing problem in the home. Risk assessments are not updated frequently enough to ensure adequate nursing intervention. An updated training programme would be of benefit to ensure all staff receives regular updated training. Medication records seen had signature gaps with no explanation why medication was omitted.

CARE HOMES FOR OLDER PEOPLE Morton House Nursing & Rest Home Morton House Droitwich Road Fernhill Heath Worcester Worcestershire WR3 7UR Lead Inspector C Presley Unannounced Inspection 12th December 2005 11.50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Morton House Nursing & Rest Home Address Morton House Droitwich Road Fernhill Heath Worcester Worcestershire WR3 7UR O1905 754489 01905 754489 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Narinder Sanghera Mrs Sheila Janette Silk Care Home 32 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 24 people for nursing care. 25th July 2005 Date of last inspection Brief Description of the Service: Morton house is a Georgian property that has been converted for use as a private nursing and rest home. The detached property is surrounded by 2.5 acres of well-stocked mature gardens, and is located on the main A38 between Droitwich and Worcester. It is close to open countryside and yet convenient to the M5 via Worchester’s Northern Link Road, making travel from the Midlands and surrounding areas easy. The registered manager is Mrs Silk who is a first level registered nurse. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the late morning and early afternoon. The inspection focused on standards not inspected at the last visit and requirements from the last inspection visit. Time was spent with the registered manager and residents who were discussing decorating the Christmas tree with the activities co-ordinator. Visitors were heard discussing visiting arrangements on Christmas Day and a family were seen taking a relative out to lunch. What the service does well: What has improved since the last inspection? What they could do better: Care plans continue to have shortfalls regarding monthly reviews and being kept updated. This is an ongoing problem in the home. Risk assessments are not updated frequently enough to ensure adequate nursing intervention. An updated training programme would be of benefit to ensure all staff receives regular updated training. Medication records seen had signature gaps with no explanation why medication was omitted. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section of the report were inspected at this visit; for further information refer to previous inspection report. EVIDENCE: Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Residents are well cared for in the home despite care plan documentation, which includes medication recording continuing to have a number of shortfalls and not always being kept up to date. EVIDENCE: There is evidence that since the last inspection the home has endeavoured to keep care plans up to date; however care plans inspected at this visit continued to evidence monthly reviews had not taken place, and current care needs had not been updated in the care plan. Risk assessments were not completed appropriately and did not give enough information to staff to care for residents. The registered manager understood the requirements to comply with the Care Homes Regulations 2001 but continued to struggle with time management to complete documentation. When the inspection commenced the registered manager was ensuring the home had enough medication for Christmas and was also managing the nursing care of the residents: from observation the home needs to investigate extra registered nurse time during the morning period which in turn would release the more senior nurse team members to complete and update the care plans. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 10 The home has a thirty-minute handover period between shifts this was commendable and gives staff the opportunity to discuss residents in detail. Documentation during this time should be kept, as it is relevant to care needs particularly as care plans were not always up to date. The home complies with disposal of medication under new legislation. Medication charts inspected had a number of signature gaps; the inspector was unable to identify if medication had been given or omitted, as codes used for medication had not been used. Hand written medication charts had not been signed by a registered nurse. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 Residents have choice and control over their lives within their physical and mental disabilities and contact with family and friends remains a priority. EVIDENCE: Residents are able to choose their times of getting up and going to bed and where they eat their meals. The home does not have a lock door alarmed facility and therefore is unable to care for residents who wander. Residents during the summer have access to the garden through the conservatory and were observed during the summer months sitting in the garden. Visitors were observed coming and going during the morning of the inspection and taking relatives out for lunch. The home has a number of Christmas events organised and residents have been taken Christmas shopping by staff. Residents are also taken to the local garden centre and the public house (both are within walking distance). Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section of the report were inspected at this visit; for further information refer to previous inspection report EVIDENCE: Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section of the report were inspected at this visit; for further information refer to previous inspection report EVIDENCE: Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 Recruitment procedures are robust and ensure vulnerable residents are protected through these procedures; the home did not have a foundationtraining programme for care staff. EVIDENCE: Staff files inspected evidenced a robust recruitment procedure, which ensured staff recruited were safe to work with vulnerable adults. Staff training records seen did not evidence all staff have received core training such as fire; health and safety, moving and handling, infection control and first aid. The registered manager said she was planning to address this shortfall. The home did not have a foundation programme in place, which ensured staff that had completed their induction period had a further training programme to follow which underpinned NVQ training in direct care. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 The home did not have a quality assurance programme in place, which ensures that the views of residents, visitors and visiting professionals to the home were considered. EVIDENCE: The home did not have a quality assurance programme in place, which ensured residents, visitors and other professionals who visited the home had their views taken into consideration and these views were collated into a report which would be available to new residents and their families. Resident’s finances were safely handled in the home and records were kept. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 x x x Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 &15 Requirement For those residents at risk of developing pressure sores a waterlow or similar scoring tool to identify risk must be reviewed at least monthly. Outstanding from last inspection Care plans must be reviewed monthly Outstanding from last inspection Risk assessments must be carried out on all activities of daily living including falls and kept reviewed and updated Outstanding from last inspection Care plans must reflect current care needs Outstanding from last inspection Prescribed creams must be only used for named residents and must be kept secure at all times. Medication must be signed for when given and if omitted appropriate codes used Records of food given to residents must be kept Emergency lighting must be tested at least monthly Timescale for action 12/12/05 2. 3. OP7 OP7 15 13 12/12/05 12/12/05 4. 5. 6 6. 7. OP7 OP9 OP9 OP15 OP19 15 13 (2) 13(2) 17 23 12/12/05 12/12/05 12/12/05 12/12/05 12/12/05 Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 18 8 OP19 23 9 OP30 12,18 10 OP33 24 11 12 OP38 OP38 13 13 13 OP38 13 14 15 OP19 OP27 16 17 16 OP38 13 There must be evidence to show that staff have received fire training at least every three months; in particular one member of night staff must have fire training Outstanding from last inspection All members of staff must receive foundation training to National Training Organisation specification within 6 months of their posts A quality assurance programme must be introduced in accordance with the requirements of Regulation 24 and Standard 33 An environmental risk assessment must be undertaken The registered manager must ensure all staff have received updated training in first aid, moving and handling, infection control, food hygiene and fire Outstanding from the last inspection All bathrooms must have lockable cabinet where hazardous cleaning products can be stored and must be locked at all times. Carpets identified during the inspection must be cleaned or replaced. The home must continue to seek and employ domestic cover over the weekend Outstanding from last inspection Water temperatures must be recorded weekly 12/12/05 30/03/06 30/03/06 12/01/06 12/12/05 12/01/06 12/01/06 12/12/05 12/12/06 Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP35 Good Practice Recommendations It is recommended trained nurse staffing levels should be reviewed particularly during the pharmacy delivery morning It is recommended that resident’s monies be audited monthly. Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morton House Nursing & Rest Home DS0000004126.V268080.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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